| NPI | 1366907420 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CT 12832) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 061245) |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2022-03-10 |